Citation Nr: 21006732 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 14-21 923 DATE: February 5, 2021 REMAND The claim of entitlement to service connection for bilateral hearing loss is remanded. The claim of entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran had active service from July 1966 to July 1970, with subsequent service in the Georgia Air National Guard. Board hearings were held in August 2017 and February 2018. Transcripts are of record. The Board remanded the appeal in May 2018 for development of the record. On remand, additional service personnel and treatment records were obtained. They include a June 1986 line of duty determination indicating that the Veteran sustained an injury to his left lower extremity in June 1986 while on temporary duty to Eglin Air Force Base. This injury was found to be in the line of duty. The Board observes that while VA examinations have been conducted and opinions obtained, no examiner has considered the June 1986 duty injury in reaching a conclusion regarding the etiology of the Veteran’s bilateral knee disability. An additional examination is therefore necessary to address this newly obtained evidence. Regarding the claim of service connection for bilateral hearing loss, the Board notes that in October 2019 the Veteran submitted an article regarding how his hearing problems might be attributable to exposure to jet fuel. In an associated statement, the Veteran indicated that he had been exposed to jet fuel in his specialty as a weapons mechanic. He argued that the research findings referenced central auditory processing dysfunction, which was a component of his hearing loss. The examination conducted on remand did not address this theory of entitlement. Thus, the Board concludes that an additional examination is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his claimed bilateral knee disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all knee conditions present. The examiner should also provide an opinion regarding the following: (a) Whether it is at least as likely as not that any such knee condition is related to active service? (b) Whether it as at least as likely as not that any such knee condition is related to disease or injury incurred in or aggravated by any period of active duty for training (ACDUTRA). (c) Whether it is at least as likely as not that any such knee condition was caused or aggravated by an injury incurred during any period of inactive duty for training (INACDUTRA). In rendering these opinions, the examiner should consider (1) the cumulative impact of wear and tear on the knees from the rigors of the Veteran’s duties in service, to include extensive bending and squatting; (2) the left knee injury the Veteran sustained in June 1984 during National Guard service; (3) the impact of the left foot/ankle injury the Veteran sustained in June 1986 during National Guard service. The examiner is also advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Schedule the Veteran for an examination to determine the nature and etiology of his claimed bilateral hearing loss. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should provide opinions regarding the following: (a) Whether it is at least as likely as not that bilateral hearing loss was incurred in, or is otherwise related to active service, to include exposure to jet fuel as a weapons mechanic. (b) Whether it is at least as likely as not that bilateral hearing loss is related to disease or injury incurred in or aggravated by any period of ACDUTRA. (c) Whether it is at least as likely as not that bilateral hearing loss was caused or aggravated by an injury incurred during any period of INACDUTRA. In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. (Continued on the next page)   If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. Then, readjudicate the Veteran’s claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Barone, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.